The Deseret News is exploring why teens are more anxious than ever and how families and communities can help. This is the latest in a multi-part series.
NORTH LOGAN, Utah —
The movie theater is sold out, and Jalen Moore has folded his 6-foot-8-inch frame into a mid-row seat.
Confinement alone makes this a stressful situation for Moore, who might still be playing in the National Basketball Association if not for the anxiety attacks that began last spring, while he was belted into a stuffy cabin seat on a plane before a game.
What’s worse, the movie he and his girlfriend are watching is “A Quiet Place.” The screen shows a post-apocalyptic world where anyone who makes the slightest sound is set upon by man-eating demons.
Moore feels hot, and begins to sweat. Instinctively, he looks for the exits, and he knows his girlfriend will understand if he decides to leave the theater. It’s happened before.
He doesn’t leave, though. He tells himself that he knows what’s happening, that it won’t kill him, and that it will be over with soon. And it is.
By one estimate, a quarter of adolescent boys will develop anxiety disorders like Moore’s, and the former Utah State basketball star has joined a growing contingent of male role models, from Michael Phelps to Steve Young, who encourage anxious boys to ignore outdated notions about masculinity and seek help.
The Child Mind Institute, a national nonprofit based in New York, says girls and boys feel pressure to perform in school, in relationships and in society, though the images they’re supposed to emulate are different. Anxiety in boys can look like angry, disruptive behavior, ADHD or even a learning disorder.
Mary Alvord, a Washington, D.C.-area psychologist and author of “Conquer Negative Thinking for Teens,” said that though more boys than girls are referred for treatment, boys tend to be referred for behavioral problems, not specific disorders, and there’s little research about anxiety in boys.
“There is a difference, culturally, for a boy,” Alvord said. “Especially a high school boy who’s trying to be macho. For him to say, ‘Yeah, I’m afraid of being home by myself,’ or ‘I worry all the time about getting things perfect,’ it’s just not cool.”
Boys are expected to be strong and “tough it out” — whether they feel that way or not. And while both boys and girls may try to mask their anxiety, boys often give up, or withdraw, avoiding school or social interactions (as Moore did when his anxiety attacks became more frequent).
Moore’s talent is such that even after he was unable to report to the Milwaukee Bucks on a two-way rookie contract last summer because of persistent, irrational and debilitating anxiety, NBA teams still inquire about his availability. He keeps in shape.
But the 22-year-old’s main focus is achieving personal victories like the one he had at the movies, thereby inspiring others to confront their anxiety head-on.
Boys in turmoil
National experts say research shows boys and girls differ in ways that may influence how they react to anxiety, though they’re quick to note a lack of significant gender difference in the impact on young lives.
Mill Valley, California, family therapist Richard Platt said boys get upset faster than girls and have a harder time calming down. That’s backed by a study the National Institutes of Health published showing boys have more “sadness, impulsivity and anger” than girls.
“Anger in males is more socially and culturally sanctioned than in females,” added Michael A. Tompkins, associate professor at University of California at Berkeley and co-director of the San Francisco Bay Area Center for Cognitive Therapy, “so it’s likely that males, when fearful and asked to do something that makes them anxious, more likely would push back and oppose.”
READ MORE: How to help your anxious boy
Few anxiety-specific studies focus just on boys. Alvord scanned research databases recently while on the phone with the Deseret News and said with a sigh, “There really isn’t very much.”
“I would like to see more, because more boys are referred than girls, and I think we need to understand where the anxiety comes in,” she said.
Because girls show a greater prevalence and are more apt to ask for help, more is known about them and their anxiety can be easier to spot. A lot of what’s known about boys is gleaned in treatment programs, rather than academic studies.
Mike Bulloch is clinical director and cofounder of the WayPoint Academy, tucked away in pastoral Huntsville, Utah — the only U.S. residential treatment center/independent school focused exclusively on treating boys with debilitating anxiety disorders. Boys come from across America and as far away as Singapore for help. (The school has an enrollment of 44.)
Bulloch said societal pressures, some driven by social media, turn the heat up on young males to appear happy and confident — even when they privately struggle with self-doubt and fear they don’t measure up. “The boys I work with are flooded with anticipatory fears, usually of rejection, failure or uncertainty,” he said.
As highly anxious boys avoid what makes them anxious, the list of things to avoid lengthens. “These are boys sitting in their rooms watching the world go by without them. Because of the avoidance, they tend to be deficient in skills,” Bulloch said.
Fruit Heights, Utah, therapist Jeffrey Gregson said anxious males may substitute fake social connections for real ones. “When they’re playing ‘Call of Duty’ or other first-person shooter games, they’re often networked with ‘friends,’ interacting so they get a pseudo-relationship. They band together as a team, so they feel part of a group or family. They get a sense of accomplishment — while avoiding anything hard in their lives."
Gregson and Bulloch said playing video games becomes problematic when boys do it to avoid other things. When they skirt what shakes them, they’re not building real skills, like coping, problem-solving, advocating for themselves and expressing their needs.
Meanwhile, because of how boys project their distress, they can be misdiagnosed — viewed as oppositional, especially at home, where they balk and argue, said Bulloch. While the young men at WayPoint are typically what he called “pleasers and rule followers,” Bulloch recognizes home life was probably different. “At home you will see a lot of behavioral disturbance,” especially when parental requests butt up against what teens desperately don’t want to do. “We’d like you to go school today” or “We need you to come out of your room” may feel less like a request than a call to battle.
That confuses parents, who may see their son not as anxious, but belligerent, uncooperative or angry — and may punish him for bad behavior.
Bulloch said often, anxious boys become so agitated that parents back down to avoid confrontation. “With severe anxiety disorder, tremendous accommodation occurs within about 80 percent of these homes."
Even parents who see that giving in doesn’t help may feel they have no choice: They have to get to work or school on time.
Successful avoidance can leave boys skill-deficient and unable to navigate life. They may develop what Bulloch calls “a sense of hostile dependency on others” — especially their parents. Society is typically unforgiving toward male dependency and the boys themselves are frustrated and angered by it, creating shame that is taken out further on family.
Anxious young men
In sixth grade in 2012-13, Aidan started panicking about what others thought of him. He decided if he could be the smartest kid in class so teachers liked him, other students would, too. For a couple of years, he tried to ensure even fleeting interactions were positive for the other person. “I couldn’t have anyone think negatively of me — especially other students,” said Aidan, now 17. (The Deseret News has chosen not to use last names for anxious youths featured in this series.)
In ninth grade — after changing schools in the Bay Area, where he lives with his single-parent mom and his younger sister — Aidan encountered bullies at school.
“I was very open with my emotions and would get teased for things like being enthusiastic about learning, or being on the verge of tears if something bad happened,” he said.
Then the teasing was too much. “I gave up,” he said.
Aidan first avoided school, then stopped leaving the house. Mostly, he holed up in his room, sleeping, playing video games or watching anime.
As he became more distressed and refused to engage with the outside world, his mom feared he would hurt himself. On days he felt he’d handled himself poorly in front of peers, he began obsessing about dying, admitting to her that his thoughts scared him. Once, out hiking together, he lingered too long on a cliff edge and she felt her panic rise. She feared her boy, once so curious and happy, was disappearing in front of her.
Aidan tried therapy and medication, but the latter made his anxiety worse. Their heightened emotions played off each other’s. In hindsight, she wishes she’d calmed herself more and said something like, “Everyone sometimes feels that they’re not OK. You need help, but you’re going to make it through this.”
When he woke her, scared of his thoughts at 3 a.m. one winter morning in early 2015 , she took him to a psychiatric hospital to be stabilized, then to a behavioral therapy unit for full evaluation. Aidan hated the inpatient programs, but his mom said he was relieved to be where he couldn’t hurt himself. From there, in April, he went to WayPoint Academy in Utah — drawn by a professional recommendation and its focus on anxious boys.
Said his mom, “I finally realized — this was my most painful moment as a parent — that I couldn’t help my son on my own. I didn’t have the tools.”
Search for anxiety’s roots and it becomes clear that little’s clear. Research offers tantalizing clues about possible factors like genetics, environment, temperament, daily stressors, even anxiety levels of those around you. Experts say the “why” may vary from person to person.
Kaleb’s anxiety, for example, started his senior year over the winter break straddling 2016-17 with a trauma, a friend’s attempted suicide. Kaleb threw everything he had into the friend’s safety as his own feelings of being overwhelmed grew into debilitating anxiety. Then he caught mononucleosis and had to scale back activities like track, increasing his unhappiness. Those he forced himself to do, like his senior trip to Southern California, were joyless.
Usually, he’d sleep until it was time to drag himself to school for advanced placement calculus. “I had put a ton of hard work into it so I knew I had to at least give myself the best shot I could at getting the credit,” he said. Mostly, he slept.
His parents were proactive. But Kaleb found medication prescribed by his therapist, like Lexapro and Vyvanse, made him feel indifferent and reckless.
“It made it so I didn’t care about anything,” said Kaleb. “I didn’t really care about relationships or if I hurt people’s feelings. I wouldn’t wear a seat belt because I really didn’t care about my safety.”
Both Aidan and Kaleb tell their stories from the other side of treatment.
Kaleb, now 19, has managed a year at Weber State University and, with therapy and a lot of family support, the Kaysville man expects to serve a mission for The Church of Jesus Christ of Latter-day Saints in the fall, before returning to college.
When Aidan went home from WayPoint to California when he completed treatment, he felt some old anxiety about being accepted. But he practices mindfulness and other strategies to keep from freezing up. He does have friends and can talk about what bothers him.
“At the boarding school, one of best things I learned was others were going through it,” said Aidan. “If someone talked to me about what they were feeling, it probably would have turned things around for me.”
Kaleb thinks he’d have benefited greatly if someone he looked up to — a musician, maybe — talked about overcoming anxiety.
Boys seem to respond more strongly than girls to role models who admit challenges and succeed anyway, said Gregson, the Fruit Heights therapist.
“I think it absolutely helps that so many athletes and others are coming out and talking about anxiety and depression. Guys like 'The Rock,' Dwayne Johnson,” he said.
“I would definitely have been influenced if a musician I admired had said something about it.” Accomplished on piano, guitar, ukulele and drums, “Music is a way that I can connect with people and feel (close to God),” Kaleb said.
“When I’m in (anxiety), it feels like it will be my whole life. Seeing someone successful doing what I want to do who got through this is reassuring.”
After costing him his first big shot with an NBA team, anxiety wasn’t finished with Jalen Moore.
When he returned home last fall to Cache Valley, where Moore and his trademark afro had attained celebrity status at Sky View High School and Utah State, he felt a nagging pressure to explain himself.
The Milwaukee Journal Sentinel had reported about Moore’s anxiety at the time of his release last September, but many in Logan missed the news. They only heard that Moore signed an NBA contract, and they were curious when they saw him about town.
Moore limited Walmart runs to late at night, when there was less risk of seeing people walking toward him and thinking, “Oh, here we go. I’ve got to tell them what happened.”
Then his agent relayed a crazy proposition: What if, instead of avoiding people, you told everybody?
The pitch had come from The Players’ Tribune, a website founded by former New York Yankees shortstop Derek Jeter to give athletes a platform to tell their own stories.
“At first I’m like, ‘Geez, I don’t really want everybody to know,’” Moore said. “But then at the same time, I’m like, ‘OK, but maybe doing the story could really help a lot of people.’ Because when I needed help the most, I really didn’t know where to turn.”
Over two hour-long phone calls with a Players’ Tribune writer, his story unfolded: How a panic attack on a bumpy flight to play in San Jose, California, had shaken his self-image, how the anxiety had persisted even without clear triggers, how his heart “was beating out of my chest” when the Bucks told him they wanted to sign him as a free agent, and how he couldn’t hear anybody else in the room at that moment.
“It was just like white noise in the background, and the sound of my own voice echoing through my head,” he said in the Players’ Tribune story, which he edited and proofread. “… How are you going to do it? Where will you live? When are you going to leave? What if you’re not good enough?”
Moore braced himself for the reaction before the piece published in March, sure commenters would say it proved Moore wasn’t man enough for the NBA.
A few did say that.
But many others — including readers in Europe and China — told Moore they felt inspired by the story. Some said they’d seek help or refer others who were going through similar challenges.
Now, when Moore goes to Walmart, people don’t ask about the NBA. They ask what anybody asks when they recognize someone in a grocery aisle: “How are you doing?”
The same month the Players’ Tribune published Moore’s story, it ran another by Cleveland Cavaliers All-Star forward Kevin Love, describing a panic attack in the middle of an NBA game against the Atlanta Hawks.
Love wrote that “men and boys are probably farthest behind” in discussions of mental health: “Growing up, you figure out really quickly how a boy is supposed to act. You learn what it takes to ‘be a man.’ It’s like a playbook: Be strong. Don’t talk about your feelings. Get through it on your own.”
Alvord, the “Conquer Negative Thinking for Teens" author, said it’s “awesome” that male role models are coming forward with their struggles.
“I think, in general, the trend is less stigma. It’s more OK to say that you’re experiencing something — it doesn’t have to rise to the level of a disorder ... you still seek help.”
Charlie, 12, of Detroit, was diagnosed with anxiety at age 7 and has struggled mightily. Then he read an interview where Olympic swimmer Michael Phelps talked about his own anxiety. Later, he met his hero.
“Your parents can tell you you’re not alone, but sometimes it takes somebody else being brave — showing you their vulnerability, their anxiety, whatever it is they are struggling with — to actually feel not alone," Charlie's mom said. "I think it’s magical because … every time someone shares their story, it extends a light to someone else who feels they’re alone and in the dark. Michael Phelps did that for my son, and I’m forever grateful.”
Moore believes those examples can spare others his experience of last summer, when he couldn’t understand what was wrong and why he wasn’t able to suppress his negative thoughts. He learned about anxiety disorders last August, when he Googled the symptoms of his panic attacks.
Said Moore: “If I would have said something to someone right as I first started feeling it, the outcome probably would have been different.”
What parents should know
Moore now lives with his parents in their pretty white corner house in North Logan.
He recently watched a lot of the World Cup, and enjoys popular video games, like Fortnite. But he also works, training youth basketball players each week at the Smithfield Recreation Center, and keeps his skills sharp in nighttime pickup games with friends. He continues to benefit from visits with his therapist, who has never applied pressure to play in the NBA.
“He was kind of like, ‘Cool that you’re good at basketball, but I want to help you.’ That was big for me, because (others) are like, ‘You’re good at basketball, are you going to (play professionally)?’"
Anxiety becomes problematic when it’s continuous, he said, and when it affects your ability to participate in life or experience happiness. He’s lived that kind of anxiety.
Experts espouse a similar message. Parents should let their kids struggle some, but be willing to talk through things. Bulloch tells parents they shouldn’t offer partial rewards for staying stuck. Reward progress, setting goals and trying — which is more important than whether it always works.
Parents and experts can help kids tackle fears in manageable ways. Each time a kid faces a fear, he gains strength to tackle a bigger fear. Seeing they survive even when what they dreaded happens, anxiety loses its control over them, he said.
“The reality is, life’s not meant to be easy. There’s a place for struggle. When a species faces adversity, it learns to adapt. We develop better skills, more insight, greater experience,” said Bulloch.
People generally don’t outgrow anxiety, though they can get better at coping with it over time, said psychotherapist Michael L. Sulkowski, who researches and teaches about anxiety at the University of Arizona. Usually, they limit exposure or blunt it — precisely what should not be done.
This fall, Moore plans to challenge his outsize fear of flying when he boards a plane to visit a friend in California.
“Obviously,” he said, “not flying isn’t gonna help me get better.”